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Prevention is the role of governments, not health systems

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I would like to challenge one statement that you made in your editorial this week: Primary prevention will reduce total health care costs. To me it is likely that it will do the exact opposite. But that is not a problem as primary prevention has one other overriding goal: To give us all as long and healthy lives as possible.

Why will successful primary prevention increase overall health expenditure? There has been an opinion that the average person will spend half of “their” money for all health care costs during their last 6 months of life. This might be an overestimation and others have calculated it to be 25-30%. This high cost makes sense as we during our last months of life are often fighting against the disease that eventually will kill us. That fight can take a lot of resources, including long stays in hospital and intensive care units, and we might also need very expensive treatments.

A high proportion of our medical costs are thus difficult to change. The other part of our total health care bill will, however, increase with the number of years we live. It might with healthy living be possible to delay disease, but even very good adherence to health recommendations cannot stop that from happening.

The longer we live the higher will thus be the chances that we will need different expensive treatments for “intercurrent” conditions before we get the one that kills us. Many of us will survive one or several cancers that often are cured or controlled with the help of modern and expensive antibodies. Some of us will need one or several expensive interventions to our coronary arteries. Autoimmune and inflammatory diseases will become more prevalent with increasing age. More and more of us will need one or several of the increasing number of expensive antibodies that can control these conditions. Etc. etc.

I therefore think that we should stop using economic arguments for prevention. The main reason for a healthy life style is to give us longer and better lives. That is a good enough. I think we fool ourselves if we believe that prevention can save not only us, for a while, but also the NHS.

From an economic point of view it is cost effective if a person like me, 68 years old and healthy, would die in my sleep. That is, however, from my personal point of view not my preferred alternative.

Law enforcement like to check illicit drugs trade or writing as "Injurious to Health" on the cigarette packs on the alcohol bottles Will not stop the sales of these products and prevents these products related health issues.

So the individual's commitments are the first and foremost important to prevent the diseases due to drug abuse tobacco and due to alcohol.

Second, lifestyle changes people in their diet behaviour and their habits are the important primary preventive measures needed by the individuals and the community to prevent the health problems.

Third, the health issues oriented awareness are also very much important for the primary , secondary and tertiary prevention of diseases and its complications in patients, families, and in the communities.

So the awareness, personal individual 's commitments, policies, regulations , rules and if needed enforcement of law can help to prevent health related issues in all stages in all countries